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<br />NAME
<br />ADDRESS _ .__ ~, J _ ,._
<br />%:? 1 5TA i E' H I ~SHWAY 13
<br />:-t~ER CO ~lrs4
<br />FACILITY :~i•l'~ t7 I'SI~lE '
<br />LocAT1oN .,=-hER ~ CO 131E•4
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<br />NATIONAL POLLUTANT Ol5CHM0E ELIMINATION SYSTEM ~NPDESI
<br />DISCHARGE MONITORING REPORT (OMRJ
<br />PERMIT NUMBER DISCHMOE Nl1MSE11
<br />MONITORING PERIOD
<br />YEAR MO OAY YEAR MO 0 Y
<br />FROM TO
<br />Fo+m Approved.
<br />ONIB No 2040-0004
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<br />NOTE: Rra~d Itatn/tVtion~ b~fw~ compl~tinq thh foam
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